Eenie Meenie Miney

I’ll be the first to admit that I have been left far behind in the vocabularic peculiarities that are now used to describe non-normative sexuality. Perhaps it’s Age, but more likely naïveté, that has led to this deficiency rather than lack of exposure.

I entered medical school in the mid-sixties when the youth were beginning to out themselves, and when some of the gloves were starting to come off -or maybe there was a growing awareness that a few of them had actually been wearing gloves. At the time -at least in my  school- Medicine seemed bicameral and only accepted two genders, male and female, with perhaps the door held slightly ajar for babies born with ambiguous genitalia or other genetic syndromes that made classification difficult.

For some of us, at least, it was a simpler time. Gender and sexual assignation were one and the same; preference as to which was really which was non-negotiable. But times and self-designation began to change; Medicine and the Law limped behind until the rift started to expose the consequences of their inaction.

I’d like to pretend that I saw these coming but, alas, I had no idea of the scope of the issue. In fact, in my mind, this straying from the norms was at best a marginal fashion. Anatomically, at least, we were what we had been assigned, and I assumed that perhaps the fullness of time and the machinations of society would iron any deviations into the acceptable crease. I had not reckoned with the discontent that enforced conformity might produce. When one has not experienced qualms, when one accepts the way the chromosomal dice have landed, it is not easy to grasp the uneasy restlessness of those few who will not play the game… or were not willing to join either team.

I say ‘few’ because I did not know; I did not understand. In time, of course, the discrepancies became too obvious to ignore in practice. At least in my gynaecological practice…

At first, there was confusion, I suppose -mine at first, perhaps- but theirs too. Not about their role, but mine. Initially, my lack of training forced me merely to listen, to empathize and then to help when and where I could. And, naïvely, I thought that was likely all that was required -and maybe all that they could reasonably expect. There was much psychological turmoil and disbelief that there was so little I could do, and yet I was relieved that I had heard them without disparaging their distress, or trivializing their problems.

But it soon became apparent that the eventual ramifications of their choices had the potential for far deeper consequences than either side had anticipated. And I’m not sure that I even appreciated the extent of the consequences of this disparity until after I retired. Only then, for example, did I come across an essay in the BBC Future series that touched upon some of the problematic issues. In an essay, Zaria Gorvett, a freelance science journalist for BBC, addressed the problem of why transgender people are ignored by modern medicine and what that might mean for their health: https://www.bbc.com/future/article/20200814-why-our-medical-systems-are-ignoring-transgender-people

‘[T]here are thought to be nearly a million transgender people living in the US… Rather than devising new ways to cope with changing social norms, transgender people are often shoehorned into inappropriate boxes instead.’

And the example she starts with is ‘a transgender man – he identifies as male but his biological sex is female. He has been living as a man for around 20 years… he is registered as a man on all his legal documents, from his passport to his medical records.’ All along, he had been taking small doses of the male hormone testosterone, but he suffered kidney failure and his condition deteriorated, therefore necessitating a kidney transplant. The criteria, for consideration of transplantation, however, differ between men and women and he lost valuable time in sorting out what criteria would apply to him.

As Gorvett points out, ‘When you factor in the large data gaps in everything from the average life expectancy of transgender people to the right dosages of medications for their bodies, along with the widespread lack of knowledge among doctors about how to address them – let alone treat them – and the high chance of them being refused treatment outright, it soon becomes clear that transgender medicine is in crisis.’

Indeed, in the UK, ‘“You can register as male or female, but you can still only choose between these two options – you can’t say if you are transgender or non-binary,” explains Kamilla Kamaruddin, a doctor who works for the National Health Service (NHS) and transgender woman. “So that’s quite difficult.” Or, if gender issues seem irrelevant to the visit, the patient may choose not to mention it, because of perceived stigma.

And, ‘The gender you’re registered as also dictates which screening tests you are invited to, meaning that thousands of transgender men could be missing out on potentially life-saving cervical (Pap) smears and breast exams, while transgender women could be missing out on abdominal aortic aneurism check-ups (or prostate cancer screenings, if they live in the US).’

Male and female physiology are different and many medications behave differently in each. ‘Females also have more sites for certain drugs to bind to, and are therefore more sensitive to them. They tend to clear them more slowly, so they are more susceptible to overdoses.’

Perhaps because of the stigma and subsequent lifestyle, ‘The group has higher rates of heart disease, certain cancers, mental health problems, suicide, smoking, and substance abuse than the general population – as well as an HIV prevalence which is  up to 42 times the national average. Transgender people are not only more likely to get sick, but less likely to seek treatment when they do.’

Still, I think we’re beginning to understand the problems they face. This gender dysphoria is an ancient condition, though, and actually gender fluidity may go back farther still. Gorvett writes about more enlightened recent attempts at assisting both with surgery and with hormonal replacement. The problem, however, is in the continuing stigmatization of those who are not mainstream. Those who do not fit neatly into societally condoned roles.

Maybe my age is tempering my reaction, or clouding my judgment, but I do wonder why there continues to be such marked antipathy to those who do not look like us, behave like us, or (gasp) think like us. Are we so insecure in who we are that we are threatened? And is it redress for the difference that we seek, an expectation of contrition? Do we really demand repentance, or is it homogenization?

I, for one, have come to think that the world would be a poorer place if we -the cis creatures- and we alone, were all that was on offer…

Memory Vaults

After a certain age, many of us have concerns about our memories. Nothing much at first, of course -just things like forgetting why you went into the kitchen, or where you put your keys. Later, it can progress to having to write down a phone number immediately after you hear it, say, rather than trusting that you will be able to recall it correctly a minute or two later. Often, it’s easier to remember things if you use little tricks, mnemonic aids, although sometimes you forget to use them, too. But why? Are things just wearing out? Are some neurons in the brain short circuiting, or actively being culled? And why such a variation in people -and, apparently, in different populations?

As one might expect, there is intense research in this field, given the demographics of an aging population base. But have you ever wondered why you don’t have many -or any– early memories of when you were a young child -especially when you were very young: a baby, for example? Surely, the brain is a sponge at that stage, and the neurons and neural connections are propagating like mad to help you learn about the new world you are encountering for the first time? This is a puzzle that has always interested me, but perhaps even more so in my dotage when I finally have the time to reflect more thoroughly on the mystery and its possible ramifications. An article in the BBC Future series written by Zaria Gorvett, helped to shed some light on the mysterious gap:   http://www.bbc.com/future/story/20160726-the-mystery-of-why-you-cant-remember-being-a-baby

I am reminded of a blurred black-and-white memory of my brother holding me in what seemed like a flower garden when I was a baby. I often refer to it as my first memory, but the faded and black-and-white characteristics suggest that it was more likely hewn from a photograph than any still inchoate proto-memory. But as the above-linked article suggests, ‘On average, patchy footage appears from about three-and-a-half.’ And that, of course, reveals another fascinating thing about what we think we remember: ‘Even if your memories are based on real events, they have probably been moulded and refashioned in hindsight – memories planted by conversations rather than first-person memories of the actual events.’ But I’m getting ahead of myself.

Why can’t we remember being a baby? As with many aspects of brain function, nobody seems to know for sure, but the article discusses several theories that might explain it. One such attempt suggests that ‘Our culture may … determine the way we talk about our memories, with some psychologists arguing that they only come once we have mastered the power of speech. “Language helps provide a structure, or organisation, for our memories, that is a narrative.  By creating a story, the experience becomes more organised, and therefore easier to remember over time,” …  Some psychologists are sceptical that this plays much of a role, however. There’s no difference between the age at which children who are born deaf and grow up without sign language report their earliest memories, for instance.’

Then there is the possibility that ‘we can’t remember our first years simply because our brains hadn’t developed the necessary equipment.’ The hippocampus, an area of the brain that is important for dealing with memories, is still developing new neurons for the first few years of life, and it is only when these additions begin to slow down that our first memories emerge. This adds another layer of mystery to the hippocampus, though: ‘is the under-formed hippocampus losing our long-term memories, or are they never formed in the first place? Since childhood events can continue to affect our behaviour long after we’ve forgotten them, some psychologists think they must be lingering somewhere.’

There is another hazy memory that also haunts me; I would be pretty sure that it’s real, except for my brother again. It was in the days before seat belts or infant car seats; my father was driving and I was sitting on my mother’s lap in the car so I would be high enough to see out of the window. We were somewhere in Manitoba on the way to the Winnipeg Beach for the first and only time -it’s on Lake Winnipeg, I think. Apparently we normally went to Grand Beach on the railway my father used to work for, so my brother remembered the year. I would have been about two and a half or three years old.

My brother, who must have been around twelve or thirteen at the time, had the back seat to himself, but I think he was mad that he couldn’t sit in the front so he kept reaching over the seat and pulling my hair. My mother, never the patient one, finally had enough and suddenly threw out her arm to smack him. Unfortunately she hit my father and the car swerved off the highway before he could stop it. None of us were hurt, but it really scared me and I began to sob unconsolably. My parents tried everything to stop me, and finally, my brother -now chastened- told me to look out of the window because there was something out there that I’d never, ever, see again. I remember his emphasis on the ‘ever’, but I also remember not wanting to obey him.

At any rate, many years later, I asked him if he remembered that time we drove up to Winnipeg Beach with our parents.

We were sitting in a little coffee shop and he put down his cup and nodded, a faraway look in his eyes. “You were a little brat then, remember?”

Actually, I thought he’d been the brat, but I supposed he meant my crying. “But you were pulling my hair, remember?”

“And you kicked dad so hard, he lost control and the car swerved off the road…” he said before I interrupted.

“That was mom who knocked his arm accidentally because she was trying to get to you.” I was absolutely clear on that. “Maybe you couldn’t see her well enough from the back seat, though” I added, trying to be diplomatic.

I remember my brother staring at me at that  point. “I was sitting in the front seat, too,” he chided. “The old cars had those big wide front seats, remember?” A wry smile appeared on his lips -he still knew how to stir me up. “And, you were having one of your usual temper tantrums and kicked out with your feet. One of them hit the hand dad was driving with and the car skidded off the road… I think it might have been gravel, or something.”

I shook my head vehemently at his pentimento, and he began to laugh like he used to do when he was taunting me. Apparently he, too, was invested in the memory. And yet, how can you verify your recollection of something that happened that long ago? I suppose I sulked for a moment or two, and then it came to me. “Ron, do you remember that I was crying even worse after the accident?” He nodded graciously, content to grant me a little face. “And do you remember that you tried to get me to stop, by telling me to look out of the window? You said if I didn’t look, I’d miss something I’d never, ever, see again?” I tried to emphasize the ‘ever’ like I remembered he had.

He thought about it for a minute. Clearly it hadn’t been a big thing for him at the time -more a trick to silence me. Then, his face brightened up. “Yes… Yes I think I remember…”

“And what was it?” I asked, leading him into my trap.

He smiled in the same smug way he always had when he was in possession of something I wanted but didn’t have. “There was a huge eagle sitting on a tree near the road. I don’t think I’d ever seen one before in the wild.”

I nodded my head pleasantly, as if he’d finally solved a mystery that had been nagging at me all those years. But I knew he was lying… No, that’s unfair! I knew he thought he was remembering what really happened back then, but he was wrong -I’d peeked. There was no eagle, and in fact we were almost at the beach and there weren’t even trees anywhere near the road. I’m sure I would have seen something that big. And yet… And yet, the eagle has been my favourite bird ever since I was a child…